USA Atenolol / Losartan Comparison Trial

Summary

This medication trial tested whether Losartan was more effective than Atenolol with regard to slowing aortic root enlargement. The trial recruited 608 Marfan syndrome participants aged from 6 months to 25 years of age. Over a 3 year period, both the treated groups showed a decrease in the rate of aortic root growth measured on serial echocardiograms. Losartan was as effective as Atenolol, but not significantly better.

What does this mean?

Previous studies indicate that Atenolol is effective, Losartan is effective, and if both are used together, the effect may be greater. Treatment could be started with Atenolol, but if side effects of dizziness, fatigue or wheezing appear, Losartan alone may be substituted. Side effects are fewer (dizziness, nausea) for Losartan. Irbesartan, a member of the same drug family, may be more effective because of its long half-life
(11-15 hours) giving 24 hr coverage. This is being tested in the UK-wide AIMS trial.

Ref: Lacro R.V. et al: Atenolol versus Losartan in Children and Young Adults with Marfan syndrome. New England Journal of Medicine, 2014 Nov 18 on-line at NEJM.org

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